Concurrent chemotherapy in advanced head and neck carcinoma – A prospective randomized trial

Purpose: The aim of this study is to compare two different concurrent chemoradiotherapy regimes – weekly cisplatin and three weekly cisplatin along with standard external beam radiotherapy in advanced head and neck cancer. Procedures: 90 untreated patients of advanced squamous cell carcinoma of head and neck were randomized into three arms: Arm A (n=30) patients received inj cisplatin 30mg/m2 weekly along with radiation; Arm B (n=30) patients received inj. cisplatin 100mg/m2 on a three weekly basis with radiation; Arm C (n=30) received only radiation. Radiotherapy was delivered to a dose of 66 Gy to 70 Gy in conventional fractionation in telecobalt machine. Findings: Complete response rate is significantly higher in arm B compared to that of arm A and arm C. Major toxicitities include neutropenia, anaemia and mucositis. Grade 3 neutropenia, anaemia and mucositis were found in arm A and arm B. No grade 3 toxicity was found in arm C. There was no grade 4 toxicity in any arm. Conclusion: We conclude that concurrent chemoradiation produce better response compared to that of radiation only. Toxicities were also increased in concurrent regimes. Out of two concurrent regimes, three weekly regimes showed better response with slightly increased but manageable hematological toxicities. Hence, this regime can be considered as standard of care for advanced head and neck cancer. Key words: Advanced head and neck cancer; Concurrent chemo-radiation; weekly versus three weekly cisplatin. DOI: http://dx.doi.org/10.3329/bjo.v17i2.8847 BJO 2011; 17(2): 88-95

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Effect of Concurrent Chemoradiation for Advanced Head and Neck Malignancy in a Tertiary Care Centre, Kerala

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/428 ◽

2021 ◽

Vol 10 (28) ◽

pp. 2094-2098

Author(s):

Ravisankar Thommanparambil Raveendran ◽

Shehna Abdul Khader ◽

Ajith Kumar Vilasini Raghavan ◽

Jayaraman Madambath Balan ◽

Krishnannair Lalithamma Jayakumar

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Response Rate ◽

Complete Response Rate ◽

Locally Advanced ◽

Complete Response ◽

Concurrent Chemotherapy ◽

Advanced Head ◽

One Year

BACKGROUND Concurrent chemotherapy is a well-established treatment modality for locally advanced head and neck cancer. The concept of concurrent chemotherapy and radiation was introduced in an attempt to improve the local control and possibly influence the survival because of the high rate of local and distant failures observed with the combination of surgery and postoperative radiation. The relevance of this study was to assess the efficacy of our treatment and patience compliance and also study the effect in patients treated with cisplatin based concurrent chemo radiotherapy in advanced head and neck cancer. METHODS The prospective study was conducted in the Department of Radiotherapy, Government Medical college, Thrissur, Kerala comprising the newly diagnosed patients with locally advanced head & neck cancers over one year. Conventional radiotherapy with a dose of 66 Gy in 33 fractions over 6.5 weeks was given concurrently with Inj cisplatin 100 mg / 2 IV every 3 weeks and periodically followed up for one year. RESULTS This study revealed that complete response rate was higher in 61 – 70 year age group compared to lower age groups. Complete response cases were slightly higher in T1 disease compared to higher stages. Regarding nodal status, complete response and DFS were more in N0 tumours and worst in N3 tumours. It was found that complete response rates were slightly higher in stage III than stage IV. Comparing the grade of the tumour, complete response cases were slightly higher in WD and MD compared to PD. Complete response rate and disease free survival (DFS) were slightly higher in cases who had more than two chemotherapy cycles compared to one cycle. CONCLUSIONS Concurrent chemo radiation was not well tolerated in our study group. Only 23.5 % patients were able to complete the planned treatment. The positive side was that complete response was found in about 79.4 % of study patients & DFS at one year was 80 %. KEY WORDS Concurrent Chemo Radiation, Head and Neck Cancer, Cisplatin

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Compliance, toxicity and efficacy in weekly versus 3-weekly cisplatin concurrent chemoradiation in locally advanced head and neck cancer

Journal of Radiotherapy in Practice ◽

10.1017/s1460396918000341 ◽

2018 ◽

Vol 18 (1) ◽

pp. 21-25 ◽

Cited By ~ 1

Author(s):

Sandeep Muzumder ◽

Nirmala Srikantia ◽

Ganesha Dev Vashishta ◽

Avinash H. Udayashankar ◽

John Michael Raj ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Locally Advanced ◽

Disease Free Survival ◽

Concurrent Chemoradiation ◽

Advanced Head ◽

Flat Dose ◽

Grade 3 ◽

Weekly Cisplatin

AbstractAimWeekly low-dose cisplatin is routinely used in concurrent chemoradiation (CCRT) in locally advanced head and neck cancer (LAHNC), despite 3-weekly cisplatin being the standard of care. We compared compliance, toxicity and efficacy in weekly versus 3-weekly cisplatin CCRT in LAHNC.Materials and methodsIn this retrospective study, weekly cisplatin 50 mg flat dose was compared with 3-weekly cisplatin 100 mg/m2, when given in CCRT in LAHNC with curative intent. The study outcome was compliance, toxicity, loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS).ResultsEighty-four patients received CCRT from January 2013 to June 2017, 40 in weekly and 44 in 3-weekly arm. There was no difference between the arms not completing scheduled radiation therapy or chemotherapy. Patient receiving 200 mg/m2 cisplatin is higher in 3-weekly arm compared with weekly arm (75 versus 40·9%; p<0·0015). Compared with 3-weekly arm, more patient in weekly arm developed grade ≥3 mucositis (52·5 versus 15·9%, p=0·0004), day care intravenous hydration (82·5 versus 38·6% <0·0001) and in-patient admission (55·0 versus 18·2%; p=0·0004). The 2-year LRC, DFS and OS in weekly versus 3-weekly arm were: 70 versus 61·4% (p=0·406); 67·5 versus 56·8% (p=0·314); 67·5 versus 61·4% (p=0·558), respectively. The median time to LRR, DFs and OS was not reached.ConclusionsWeekly cisplatin is comparable with 3-weekly cisplatin in terms of compliance, disease control and survival, but with increased grade 3 mucositis and higher admissions for supportive care.

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“CLINICALASSESSMENT OF TREATMENT RELATED TOXICITY AND RESPONSE BY CONCOMITANT CHEMORADIATION THERAPY IN LOCALLY ADVANCED HEAD AND NECK CARCINOMA”

10.36106/ijsr/0902974 ◽

2021 ◽

pp. 79-81

Author(s):

Swapan Kumar Mallick ◽

Rinki Saha

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Treatment Options ◽

Locally Advanced ◽

Stage Iv ◽

Head And Neck Carcinoma ◽

Complete Response ◽

Advanced Head

Introduction: Head and neck cancer is the commonest malignancy in India. Most of the cases present are at a locally advanced stage. Concurrent chemo radiotherapy is one of the treatment options in locally advanced Head & Neck Cancer patients. Materials & Methods: Locally advanced head and neck cancer patients attending the Out Patient Department of Radiotherapy from May 2018 to February 2020. Patients were treated with concurrent chemoradiation and followed for a minimum period of 9 months. Results: On analysing the pattern of response, it was noted that, in the chemoradiation complete response was seen in 20 patients (66.66%), partial response in 6 patients (20%), stable disease in 2 patients (6.66%) and progressive disease in 1 patient (3.33%). In our study, complete Response in case of Stage III was seen in 18 patients and other form of response was seen in 3 patients . In case of Stage IV A and IV B , Complete Response in 2 patients and other form of response was in 6 patients respectively. Haematological toxicities like neutropenia (3.3%), thrombocytopenia (0%) and anaemia (3.3%) were seen. Acute toxicities like oral mucositis and skin reaction were observed 10% in both the cases. Conclusions: The present study, Concomitant chemoradiotherapy improved overall survival and locoregional control. Preservation of function is a major endpoint of interest.

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